微柱凝胶法检测ABO母婴血型不合孕妇血清抗-A（B）IgG效价1154例的结果分析

目的探讨微柱凝胶法（MGT）检测1 154例ABO母婴血型不合孕妇血清抗-A（B）IgG效价的临床意义。方法采用MGT法对1 154例ABO母婴血型不合孕妇进行产前血清抗-A（B）IgG效价测定,分析血清抗-A（B）IgG效价与新生儿溶血病（HDN）发生的相关性。结果 1 154例孕妇在孕20周首次血清抗-A（B）IgG效价测定≥1∶64者占72.36%（835/1 154）,其中O-A型、O-B型和O-AB型夫妇抗-A（B）IgG效价的阳性率分别为72.48%（366/505）、66.45%（313/471）和80.90%（144/178）,各组阳性率差异有统计学意义（χ2=13.765,P〈0.01）。在产前第30周左右对1 154孕妇中的340例进行抗-A（B）IgG效价的二次随机测定,发现50.50%（51/101）孕妇抗体效价从阴性转为阳性,51.80%（129/249）孕妇（效价≥1∶64）抗体效价继续上升,其中O-A型、O-B型和O-AB型夫妇抗-A（B）IgG效价上升率分别为53.74%（79/147）、50.00%（77/154）和56.41%（23/39）,各组间差异无统计学意义（χ2=1.130,P〉0.05）;25例发生HDN的患儿母亲产前抗-A（B）IgG效价测定均≥1∶256,其中有12例血型抗体效价持续升高达4倍以上,1例效价〈1∶64。结论 ABO母婴血型不合孕妇血清抗-A（B）IgG效价水平与HDN的发生显著相关,利用MGT检测孕妇血清抗-A（B）IgG效价有助于HDN的早期诊断和干预。     

新生儿溶血病凝血功能变化的研究

目的 探讨新生儿溶血病凝血功能的变化及其临床意义.方法 以新生儿溶血病(溶血病组)、非溶血性高胆红素血症(非溶血病组)患儿各60例为研究对象,同期出生的60例正常足月儿为对照组.测定各组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数.结果 溶血病组PT、APTT明显高于非溶血病组[(28.79±4.21)s比(18.98±241)s和(58.52±313)s比(47.26±5.81)s],且两组明显高于对照组[(13.81±1.83)s和(38.10±3.00)s],差异有统计学意义(P<0.05),而血小板计数比较差异无统计学意义(P>0.05).结论 新生儿溶血病有出血倾向,与血小板计数无关,而与PT、APTT延长有关,溶血程度越重,PT、APTT升高越明显.PT、APTT可作为新生儿溶血病患儿凝血功能检测的指标和疗效评价指标.

Abstract：

Objective To investigate the clinical significance and coagulation function changes in newborn hemolytic disease. Method The newborn hemolytic disease ( 60 cases, hemolytic disease group ), non-hemolytic hyperbilirubinemia (60 cases, non-hemolytic hyperbilirubinemia group) and normal newborn (60 cases,control group) were selected as the study subjects, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured, and the blood platelet count at the same time was detected. Results PT and APTT in hemolytic disease group were higher than those in non-hemolytic hyperbilirubinemia group[(28.79 ?.21) s vs. (18.98?.41) s and (58.52?.13) s vs. (47.26?.81) s], and they were apparently higher than those in control group [(13.81 ?1.83) s and (38.10 ?3.00) s], the difference had statistic significance (P<0.05). There was no statistic significance to detect the blood platelet count (P> 0.05). Conclusions The newborn hemolytic disease has the bleeding tendency, and the bleeding tendency has no relationship with the quantity of the blood platelet, but relates to the extension of PT and APTT. The more serious the case is, the more obvious the PT and APTT rise. PT and APTT can be as the detection index and evaluating effect of the newborn hemolytic disease coagulation function.     

新生儿溶血病D-二聚体变化的临床研究

目的探讨新生儿溶血病D-二聚体水平变化及临床意义。方法选取新生儿溶血病患儿60例,按照胆红素水平分为非重度组（34例）和重度组（26例）。同期出生的40例正常足月儿为对照组。检测各组D-二聚体及纤维蛋白原(FIB)水平的变化。结果重度组、非重度组D-二聚体水平[分别为(9.29±11.34)、(0.84±0.77) mg/L]明显高于对照组[(0.45±0.06) mg/L](P＜ 0.01或＜0.05),重度组明显高于非重度组(P＜0.01)。各组FIB水平比较差异无统计学意义(P＞0.05)。结论重度新生儿溶血病患儿体内存在高凝状态,血浆D-二聚体水平测定对新生儿溶血病患儿的病情判断和治疗有一定的价值。     

母婴Rh血型不合胎儿和新生儿溶血病相关临床问题研究

母婴Rh血型不合胎儿和新生儿溶血病(Rh-HDFN),是胎儿或新生儿同种被动免疫溶血性贫血最常见原因之一。Rh-HDFN导致的胎儿或新生儿病情危重,可引起胎儿严重贫血、水肿、心力衰竭、死胎,或导致新生儿核黄疸及死亡等,而幸存Rh-HDFN新生儿,则可能遗留智力发育不全、运动功能障碍等神经系统后遗症。临床对于Rh-HDFN的早期诊断、及时治疗与胎儿及新生儿预后的关系紧密相关。Rh-HDFN的产前预防,越来越受到产科临床的关注。笔者拟针对Rh-HDFN临床相关问题的最新研究进展进行阐述。     

The hollow fiber assay for drug responsiveness in the Ewing's sarcoma family of tumors

OBJECTIVE: To investigate the use of the National Cancer Institute's hollow fiber assay (HFA) to evaluate and prioritize novel treatment strategies for clinical trials in the Ewing's sarcoma family of tumors (ESFT). STUDY DESIGN: The growth and morphology of ESFT cell lines in hollow fibers (HFs) was characterized in vitro and in vivo. Reliability and reproducibility were evaluated using doxorubicin. RESULTS: The numbers of viable cells in all 6 ESFT cell lines increased with time in vitro (0 to 96 hours). The SKES-1 and A673 cell lines grew exponentially after implantation of HFs in nude mice at subcutaneous and intraperitoneal sites. ESFT cells formed highly organized distinctive morphology within the HFs in vitro and in vivo. The number of viable ESFT cells within the HFs decreased in a time-dependent (24 to 96 hours) and dose-dependent (1 to 10 mg/kg) manner after treatment with doxorubicin in vivo. CONCLUSIONS: The HFA is a versatile short-term in vivo model that may be exploited to predict efficacy of potential anticancer agents in ESFT cells. Tumor markers and pharmacodynamic endpoints may be quantified in the pure population of ESFT cells from within the HFs.     

Intrauterine fetal transfusions in the management of fetal anemia and fetal thrombocytopenia

During the past 40 years, rhesus alloimmunization has gone from being one of the major causes of perinatal mortality to an almost eradicated disease. The unraveling of the pathophysiology, the development of reliable diagnostic tools, a very effective prophylaxis program, and for those (nowadays rare) cases slipping through the prevention system the availability of treatment by intrauterine blood transfusions, together constitute one of the great triumphs in modern medicine. Although Rh-D alloimmunization remains the most common indication for fetal blood transfusion therapy, an increasing percentage of these procedures is used to treat other causes of fetal anemia such as Kell alloimmunization and parvovirus B19 infection. Apart from transfusing blood, the same technique can be used to transfuse platelets to thrombocytopenic fetuses. This chapter describes the technique of fetal transfusion, and reviews the current management of fetal anemia and fetal thrombocytopenia.     

胎儿及新生儿免疫溶血性疾病研究进展

胎儿及新生儿免疫溶血性疾病是由母体IgG型同种免疫性红细胞抗体进入胎儿体内,作用于表达抗体对应抗原的胎儿红细胞,以胎儿及新生儿溶血为主要病理过程,以贫血和新生儿黄疸为主要临床表现的围产期常见疾病。本文综述了国内外近年来在胎儿及新生儿免疫溶血性疾病的病理生理、红细胞同种免疫性抗体与胎儿及新生儿免疫溶血性疾病的临床相关性、妊娠同种免疫的实验室检测,以及胎儿及新生儿免疫溶血性疾病高危病例的临床评估、治疗和预防方面的研究进展。     

病理性黄疸新生儿葡萄糖6磷酸脱氢酶及新生儿溶血病血清学检验结果分析

目的探讨新生儿溶血病（HDN）血清学检验及葡萄糖6磷酸脱氢酶（G6PD）定量测定在病理性黄疸患儿病因诊断中的意义。方法按检验操作规程对出生后1周内发生病理性黄疸的患儿进行HDN血清学检验和G6PD定量测定。结果（1）在416例黄疸患儿中．母子ABO血型不合的HDN有108例（25．96％）。其中，母／子血型为O／A（B）组合的患儿HDN发生率极显著高于母／子血型为A（B）／B（A）组合的患儿（P〈0．01）。（2）在416例黄疸患儿中，母子Rh血型不合的HDN仅有1例（0．24％）。（3）在416例黄疸患儿中，G6PD缺乏的有80例（19．23％）。其中，G6PD缺乏的男性息儿极显著多于女性息儿（P〈0．01）。结论HDN和G6PD缺乏是本地区新生儿发生病理性黄疸主要的病因；对黄疸患儿及时进行HDN血清学检验及G6PD定量测定，对选择治疗方案有重要的意义。     

重症新生儿溶血症换血治疗中的监测与处理

目的 :回顾性分析新生儿溶血症换血治疗中的监测与处理 ,并推荐一种便利安全的换血双通道。方法 :对 5例 6人次重症新生儿溶血症实施换血治疗 ,在静脉复合麻醉下以患儿血容量的 2倍进行同步换血 ,并监测心电图、脉搏血氧饱和度、呼吸频率、肛门温度、中心静脉压。结果 :换血过程中血清电解质、血糖及血肌肝无明显变化 ,而随换血量的增加 ,中心静脉压呈升高趋势 ,体温呈下降趋势。结论 :⑴安定氯胺酮静脉复合麻醉可满足换血治疗的要求 ;⑵经脐静脉插管及外周套管针双通道配合三通装置 ,方便安全 ;⑶换血过程中静脉压的变化具有指导换血速度及换血量的作用。     

32例RhD阴性孕妇产前胎-母免疫状态分析

目的 探讨RhD阴性孕妇产生抗-D抗体的影响因素及与Rh新生儿溶血病的关系。方法 对32例RhD阴性孕妇及其新生儿进行D抗原的间接抗人球蛋白实验和红细胞D抗原的吸收发散实验，并采用聚合酶链式反应(PCR)技术和DNA序列分析技术分析弱D表型孕妇的RHD基因型，同时采用流式细胞术，分析多次妊娠的RhD阴性孕妇的胎-母出血状况。结果 在32例初筛RhD阴性孕妇中，18例孕妇妊娠两次以上。在这18例中，有3例为D^el表型，1例为部分D^ⅥⅢ型，其余14例真实RhD阴性孕妇中有2例产生抗-D抗体，13例在其外周血中，应用流式细胞术检测到胎儿红细胞。初次妊娠的RhD阴性孕妇均未检测到抗-D抗体。结论 在初次妊娠的RhD阴性孕妇中，抗-D同种免疫少见；14．3％多次妊娠的D阴性孕妇产生抗-D抗体，导致Rh新生儿溶血病发生；未观察到D^ⅥⅢ型和D^el表型个体产生抗-D免疫反应。